ADEQUACY OF THE WATER FLUORIDATION
CONTROL PROGRAM IN SOUTH DAKOTA
An Evaluation of Water Fluoridation
At Selected Water Supply Systems
In the State of South Dakota
Thomas N. Hushower, P.E.
Chief, Special Studies Section
Office of Water Program Operations
Environmental Protection Agency
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u
EPA Region VIII LIBRARY
Denver, Colorado
CONTENTS
Page
Introduction 1
Evaluation Procedure 4
Summary of Findings 10
I. Analytical Control of the Fluoride Ion Level 13
II. Fluoride Chemical Feed Equipment and Facilities 14
III Fluoride Chemical Compound Storage and Handling 15
IV. Operator Training and Interest 16
V. Surveillance 17
Conclusions and Recommendations 20
Appendices 26
LIST OF TABLES AND FIGURES
Table
I
- Fluoridated Water Supply Systems in South Dakota
2
Table
II
- Fluoridated Water Supply Systems Selected for Study
7
Table
III
- Analysis of Samples from Selected Fluoridated
Water Supply Systems
11
Table
IV
- Summary of Fluoride Check Sample Analysis Results
12
Table
V
- Adequacy of Fluoridation at Selected Water
Supply Systems
19
Fig. 1
Fig. 2
- Fluoridated Water Supply Systems Selected for Study
- Operating Conditions at Selected Fluoridated Water
Supply Systems
6
18
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ADEQUACY OF THE WATER FLUORIDATION CONTROL PROGRAM IN SOUTH DAKOTA
Introduction
On March 25, 1969, the State of South Dakota enacted legislation
requiring the fluoridation of all municipal water supplies serving
populations of 500 or more. 1/ In September 1973, sixty-four communities
with a total population of 327,900 (1970 Census) were fluoridating.
Table I, Fluoridated Water Supply Systems in South Dakota, tabulates
%
the water systems reported fluoridating and the date fluoridation was
started. Recognizing the importance of controlling the fluoride ion
content in the water distribution system to within the recommended
range for optimum dental benefits, the South Dakota Department of Health
requested the Water Supply Division of the Environmental Protection
Agency (EPA) to evaluate the adequacy of the State program responsible
for surveillance of the fluoridated water supplies in South Dakota. 2/
This Report on the "Adequacy of the Water Fluoridation Control Program
in South Dakota" has been prepared in response to the request.
The recently established State Department of Environmental Protection,
Office of Air and Water Quality, Water Hygiene Program, is responsible
for approval and surveillance of the operations of all public water
supplies in South Dakota including all fluoridation installations. This
V A copy of the South Dakota Fluoridation Law approved March 25, 1969,
is included in the Appendix.
2/ A copy of the letter from the South Dakota Department of Health to
the Environmental Protection Agency requesting the evaluation is
included in the Appendix.
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2
SOUTH DAKOTA FLUORIDATION PIIOGRAM [VALUATION
Table 1
Fluoridated Water Supply Systems In South Dakota
Water Supply System
Location Date
(County) Fluoridation
1970 Census
Started Copula I ion
Water Supply System
Location Date
(County) Fluoridation Started
1970 Census
Population
Aberdeen
Belle Fourche
Beresford
Bowdle
Box Elder
Brandon Hater Co.
Brldgewater
Brltton
Brookings
Burke
Canlstota
Castlewood
Centerville
Chamberlain
Clark
Brown
Butte
Union
Edmunds
Pennington
Minnehaha
McCook
Marshall
Brookings
Gregory
McCook
Haml 1 n
Turner
Brule
Clark
2/51
1/71
7/71
7/72
4/73
1/71
10/72
6/71
12/61
5/72
10/72
4/73
7/73
7/71
11/71
26,476
4,236
1,655
667
607
1.431
1)33
1 ,465
13,717
692
636
523
910
2,626
1 ,356
Lead - Deadwood
Madison
[•'art in
KcLaughlin
Mi 1 bank
Mitchell
Kohndge
Murdo
IMrkPi
Parkston
Phil ip
Pierre
Rapid City
Rapid Valley Water
Service Company
Lawrence
Lake
Bennette
Corson
Grant
Davidson
Walworth
Jones
Turner
Hutchinson
Haakon
Hughes
Penninyton
Pennington
10/70
5/70
11/71
10/72
4/68
11/54
3/5?
9/7?
1/69
1/72
5/72
8/68
8/70
7/71
5.420
2,409
6,315
1,248
8G3
3,7?/
13.4.'r,
4 ,54 5
r.t'j
1,005
1 .611
m
9,099
11,836
1 .noo
C!e:r Lake
11/71
^ in
i«, r~i.
-i i -ii
1 ,351
luster
Ulster
a/l\
»,:>*/
bCOC) d (10
oom noiiim;
H//2
Dell Rapids
Ulnnehaha
8/71
1,991
Selby
W.ilwurth
5/7 2
95/
DeSmet
Kingsbury
10/71
1.335
Sioux Tails
Kinnehalia
10/70
72,4.;i
Estell1ne
Haml1n
10/72
621
Sisseton
Rot.erls
4/72
3/:
Faith
Meade
6/7?
Sneer f i -,h
Ll'iwi lih.c
11/70
Flandroau
Koody
9/71
2 ,0?7
Sprinqf icld
Bon Honfno
6/67
i /,(,f.
Fort Pierre
Stanley
3/7?
i xm
SI urii ir.
llc.ido
1 ?/70
'i , j ' £;
f reeman
Hutchinson
i m
} ,357
Venn j 11 ion
Clay
10/51
'j , i /ii
Gregory
Gregory
7/G0
i tvy>
iirooHnqs
4/7?
O'v
Hartford
Hlnnehaha
1/73
800
Waqner
Charles Mix
7/71
1 ,f/.S
Hlghmoro
Hyde
1/7?
1 ,173
Wdtorlov/n
L'.id 1 iiy ton
9/51
\z:rA\
Hosmer
Edmunds
4/57
137
Wf-bstor
Doy
1/70
Hot Springs
Fall River
10//(J
4,431
Wc'iSinnton
Jerauld
5/66
' ,3'j'j
Koven
Potter
7/7?
G7l
Winner
Iriup
8/70
Huron
Bt?dle
9/'/,
14,290
V'oonsocr't.'L
Sanborn
5/72
c) '
I'.cCook Lake
Union
19/7?
r;%
Y,j nk toil
Y'iril.tnn
11/70
; 1. ¦}:'
Lake Andes
Charles Hi*
1/7?
'"Mfj
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3
responsibility was transferred from the State Department of Health
when the Department of Environmental Protection was created.
Regulations for the fluoridation of municipal water supplies in the
State are prescribed in the SDCL Chapter 34-24A, and State Health
Department Regulation 2.17. (Copies of these regulations are included
in the Appendix.) The State recommended fluoride ion range in
municipal water supplies is 0.9 - 1.7 mg/1 with an optimum level of
1.2 mg/1 fluoride; however, the Water Hygiene Program policy is to
require municipal water supplies fluoridating to control the fluoride
ion content to within a range of 1.0 - 1.4 mg/1.
In addition to the sixty-four fluoridated community water supply systems
in the State, twenty-seven communities, population 15,000, were using
water sources containing natural fluorides within the recommended
range (0.9 - 1.7 mg/1); and twenty-one communities, population 9,600,
were using water sources containing natural fluorides within a range of
1.8 - 2.4 mg/1. Sixty communities, population 24,500, were supplying
water with natural fluorides greater than 2.4 mg/1 or two times the
recommended optimum level. (A tabulation of community water supplies
in South Dakota containing natural fluorides of 0.9 mg/1 or higher and
a map locating the communities with natural fluoride levels > 2.4 mg/1
are included in the Appendix.) There were 276 reported public water supplies
in the State January 1971, not including two rural water districts and
federal, state, Indian and housing subdivision water supplies. 2/ Ninety-one
communities serving a population of 343,000 (1970 Census) or 33 percent
2/ South Dakota Public Water Supply Data, January 1971, Division of
Sanitary Engineering and Environmental Protection, South Dakota
State Department of Health.
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4
of the public water supplies in the State were, therefore,
supplying or attempting to supply water containing fluorides within
the recommended limits. South Dakota, one of nine States with a
mandatory fluoridation law, ranks 7th of all States in percentage of
population of public water supplies with natural or controlled
fluoridation.
The proven benefits in dollars derived from fluoridation to prevent
dental caries for the population in South Dakota presently served by
fluoridated water are estimated to be $3.0 million annually.—/ The
annual cost to the sixty-four communities to fluoridate their water is
estimated at $52,500 and the annual cost to the State for imDiementing
a satisfactory fluoridation program is estimated at $50,000 giving a
benefit cost ratio to the State of 29 to 1. To receive full value of the
benefits of fluoridation, it is essential that the fluoride ion level in
the water supplies of the communities presently fluoridating be
maintained as close to the optimum value (1.2 mg/1) as possible since
a reduction of as little as 0.2 mg/1 below the optimum can reduce the
benefits of fluoridation by 50 percent.
Evaluation Procedure
To evaluate the adequacy of the South Dakota Department of Environmental
Protection's water fluoridation control program, eighteen fluoridated
water supply systems were selected for survey. The choice of eighteen
systems representative of the sixty-four fluoridation installations in
South Dakota was based on geographical location, population served, source
4/ Calculations of the Fluoridation Benefits in South Dakota are included
in the Appendix.
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5
of water supply (ground or surface water), and fluoride compound used in
fluoridation. Figure 1, Fluoridated Water Supply Systems Selected For
Study, locates the eighteen installations and Table II summarizes pertinent
information on each facility.
The survey of the eighteen representative fluoridation installations
included a review of the state fluoridation records for the supply, a
field inspection visit to the facility, completion of a survey form,—''
and collection of water samples for fluoride ion analysis. Each
installation was examined with respect to: fluoride ion content in the
distribution system; analytical control of the fluoride ion level (records
kept); fluoride chemical feed equipment and facilities; fluoride chemical
compound storage and handling; operator training and interest; and,
survei1 lance.
The actual level of fluoride ion in the distribution system is the single
most important factor in evaluating the adequacy of a community water
fluoridation effort and hence in evaluating the State program responsible
for approval and surveillance of the installation. However, as distribution
samples collected on one particular day may not give a true picture of day-
to-day operating conditions, the installations were also evaluated with
respect to the following:
57 A"copy of the questionnaire used in the South Dakota Fluoridation
Survey is included in the Appendix.
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SOUTH DAKOTA FLUORIDATION PROGRAM EVALUATION
Figure 1
Fluoridated Water Supply Systems Selected for Study
1 - Belle Fouche
2 - Bowdle
3 - Box Elder
4 - Britton
5 - Cariistota
6 - Custer
7 - Mobridge
8 - Parkston
9 - Philip
10 - Pierre
11 - Rapid City
12 - Sioux Falls
13 - Spearfish
14 - Sturgis
15 - Volga
16 - Watertown
17 - Webster
18 - Woonsocket
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7
SOUTH DAKOTA FLUORIDATION PROGRAM EVALUATION
TAMIL II
FLUORIDATED WATER SUPPLY SYSTEMS SELECTED FOR STUDY
Water Supply System
Population
Served
Source of Supply
Avg. Use
(HGO) 1/
Tluorlde
Compound
Typo of
Feeder
Analysts
Met tod
Belle Fourche
Bowdle *
Well II
2
3 J 4
6
Box Elder
Well #1
2
Britton
Canistota *
Custer
Well n
4
5
Hobridge
Parkston *
Philip •
Pierre
Well ft
2
3
4
5
e
7
8
Rapid City *
Rapid Creek
Girl Scout
Headowbrook
oat-*.--:,:! i'jrmy
Sioux falls *
Soearfish
Spearfish Canyon Cr.
Spearfish Park Spr.
Dickey Wei 1
Sturyis
Well M & 3
Warren Creek
Well iZ
Volga
Well «3
3
Watertovn
Plant »1
fcarcpeska
Well '4
5
8
Webster *
Wconsuckct *
Well pi
2 y
wells)
4,500
700
1,700
1,450
600
1,800
4,900
1,600
1,400
9,800
49,000
80,000
6,400
5,COO
1,000
14,600
2,20U
800
Infiltration Gallery
5 - Wells
2 - Wells
White Lake
2 - Wells
3 - Wells
Oahe Reservoir
2 - Wells
Lake Waggoner 8 Artesian Well
8 - Wells
Rapid Cr., 2-lnfiliration
Galleries, Jackson Spr.
30 - Wells 4 Sioux P..
Spearfish fr., ^tvarfUh Spr.
1 - Well
3 - Wells, Warren Cr.
5 - Wells
8 - Wells, Lake Kampcska
5 - Wells
2 - Wells
0.5 W
2.5 S
0.05 W
0.17 S
0.06 W
0.08 S
0.16 W
0.28 S
0.05 W
0.06 S
0.15 W
0.25 S
0.30 W
1.50 S
0.18 W
0.30 S
0.12 W
0.30 S
1 .70
7.30
11 .0 W
lR.n s
1.1 U
2.4 S
0.40 W
0.98 S
0.20
2.0
0.16 W
0.35 I
0.04 W
0.07 S
VT
VT
VT
VT
VT
VT
VT
VA
VT
VT
VT
VT
VT
VT
VT
VA
VA
VA
VA
VA
VA
VA
VA
VS
VS
VS
VS
VS
VT
VT
VT
VT
VT
VT
VT
VT
VT
VI
VT
VS
VS
VT
VT
VT
VT
vr
PS-1
PS-2
PS-2
PS-2
PS-2
PS-3
PS-3
P-l
PS-2
PS-3
PS-3
PS-3
V-l
PS-4
PS-5
P-l
P-l
P-l
P-l
P-l
P-l
P-l
P-l
V-2
V-3
V-3
V 3
G-i
PS-1
PS-1
PS-1
PS-5
PS-1
PS-5
PS-6
PS-7
PS-6
PS-2
PS-2
V-2
V-3
PS-2
PS-2
PS-4
PS-5
PS-2
Fluoride Confound
"VA" - HuoJiIici'" Acid
VS - Sodium Silicofluoride
VT - Sodiu.n Fluoride
Analy.i'. Method
"V - jpadn'V
Test Er,uip,ncnt_
T-T Ph¥toneter - Hach DP.
T-2 Spectrophotometer - B & . Spcctronlc 20
1-3' Spectrophotometer - Hach DP./2
* representative i'ttefid<-d Flunridr Determination-, in Wdler
Training Cour'.n, Huron, S.C. , flov. 20-30, }')}?.,
Wj'C of fividpr
""E^T'GrTilnT^l.ri'. ¦ BIF 31-12 i.o'.s-iri-Weiqht
P-l Dioolirwii iVip - iJ f- i A-v4/
V-l Volumetric - C1F 50-A I'uULirni Disk
V-2 Vcliiir.eLnr - i/ i T A-S91 S'r'ji; Type
V-f Voliralric - W fi T A-3/8 Poll rync
i'S-1 Difii'hrari Pii'p - W S I A-747, S.'iturator
PS-2 [iidphrcin Puujf - V,1 ~ 94-101), S-iLur^tor
PS-3 D107) h»"rtni i"rnp - W T A - 71 f i, Saturator
l'!>-4 Diaphram P-jitin - 1/ t> \ S.it'.n-iitur
["-!> Oiephrjm f unit' • W b 1 A-710, '.cUur'titur
F-S-f) Li^phrj)!! ru.i-n - F \ i' 71 P. ?00(\ S.iturdUn*
PS> 7 Uloi/hivm I'Ki'ii- • I'O' Murlnlr,, j.it'ir-Mtur
T-l
T-l
T-l
T-l
T-i
T-l
T-l
t-:
T-i
T-l
T-2
T-l
T-!
1-i
T-:
T-l
1/ W-Winter; S
7/ Supply Not Fluoridated
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8
Analytical Control of the Fluoride Ion Level
A. Were the fluoride ion analyses conducted at the water plant
accurate within + 0.1 mg/1 of the value determined by the
Environmental Protection Agency?
B. Were finished water samples analyzed daily or more frequently
for fluoride ion content?
C. Were raw water samples analyzed regularly for fluoride ion
content?
D. Were laboratory equipment and facilities at the water plant
adequate to conduct fluoride ion analysis according to one of
the three standard methods?
E. Was laboratory equipment clean and given responsible care?
F. Were complete records kept of the fluoride operation?
. Fluoride Chemical Feed Equipment and Facilities
A. Were the fluoride feed equipment and facilities adequate
to control the fluoride ion level in the finished water?
B. Was positive protection provided against overfeeding?
Was backflow protection provided? Was equipment location
and point of fluoride chemical application at the best
practical site? Was the feed equipment site uncluttered?
C. Was the fluoride chemical feed installation operated
continuously for the past twelve months without an interrup-
tion of more than one day?
D. Were the fluoride chemical feed equipment and facilities
maintained satisfactorily?
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9
III. Fluoride Chemical Compound - Storage and Handling
A. Was the fluoride chemical compound stored in a safe,
protected and orderly manner?
B. Was safety equipment available and were safe procedures
followed in handling the fluoride chemical compound?
C. Were fluoride chemical shipping containers disposed
of satisfactorily or re-used only for fluoride chemical
storage?
IV. Operator Training and Interest
A. Were plant operating personnel well-trained to operate
the fluoride chemical feed equipment and facilities?
B. Were personnel conducting the fluoride ion analyses
knowledgeable of their test equipment and standard
procedures for analysis?
C. Was the water plant official interviewed in favor of
fluoridation and was he interested in adding fluorides
to public water supply systems?
V. Surveillance
A. Were check samples for fluoride ion analysis submitted to
the state as required?
B. Had the water fluoridation installation surveyed been
inspected in the past twelve months by a representative
of the state water supply program surveillance agency?
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10
Summary of Findings
Data collected on the eighteen surveyed fluoridated water supply systems
in the State of South Dakota indicated ten (56 percent) of the systems
contained a fluoride ion content in the distribution system at the time of
the survey within the 1.0 - 1.4 mg/1 range required under the policy of
the State Water Hygiene Program. Eight (44 percent) of the facilities
were overfeeding, i.e. the fluoride ion levels in the samples collected
from the distribution systems were greater than 1.4 mg/1. Table III,
Analysis Of Samples From Selected Fluoridated Water Supply Systems,
tabulates the fluoride ion analysis of the water samples collected at
each facility surveyed. (Water distribution systems samples collected
during the survey by the EPA were analyzed for fluoride ion content by
the Electrode Method. Check samples, analyzed by the EPA and the South
Dakota Laboratory, Table III, had a variation between 0.01 - 0.11 mg/1
with an average difference of 0.05 mg/1. The State Laboratory used the
Electrode Method for analysis and analytical procedures and technique
followed were judged very acceptable. Duplicate samples were also
analyzed with the Sioux Falls Health Department Laboratory, responsible
for fluoride check sample analysis with the Sioux Falls Water Department--
results were within 0.06 mg/1 fluoride.)
A one year summary of the State Laboratory fluoride ion analysis check
sample results for the installations surveyed is presented in Table IV,
Summary Of Fluoride Check Sample Analysis Results. Of 534 fluoride
samples received by the State from the installations surveyed, only
67 percent were within the 1.0-1.4 mg/1 range while 20 percent were
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SOUTH UA<.1)1 A l-'LU/kUAl iON RUGliArt (.VALUATION
r,r.i.r ! 11
ANALYSIS OK SAMPl.rS FW Sl'irnLI) I IJiOPIfi'irO WATR SUPPLY SYSTEMS
Water Supply Systen
D.nc
of
Sdivple
r>.„;, ' "
Water
Oper.i tur
r I:,(j:-1
•¦¦¦. T. -r u r
Sui le
|e ton tent
TPA
,.SVll -
Distribution Sys'nn
liclle Fourche
VIJ
O.L'j
>2.0
2.90
1 ,/6
2 . 'JO
Uowl 1 e
Well #1
3 A -1
6
10/IS
0.34
1 4
! .,Vj
1. i'.'l
1 .<;'j
i .co
fcox Llder
! VM1 #1
2
0/11
0.49
0.69
i . 6
1.71
1 70
1 .55
1 .70
f.r i '.ton
10/16
0.24
1 .3
1 .45
1.43
1 .47
1.50
C.'i:KStOta
10/18
0.55
2.0
1 .61
1.58
1.28
1 .27
Custer
Well «2
4
C
9/14
*
*
1 .2
1 .20
1.30
1.23
1 .23
1 .23
J
Hobridge
Parl.iton
10/15
10/If!
0.52
o.se
1.5
1 .62
1 .25
1 .19
1.24
1.28
1.33
1 .28
1.14
1 ,C8
Phi 1lp
L.ile Waquoner
Artesian Well
9/14
0.45
1 .98
1.7
1 .47
2.20
1.49
1.49
Pierre
Well «l
2
3
4
9/10
*
*
*
»
1 .31
1 .38
1.22
1 .37
1.28
1 .72
1 .22
1 37
)
1 c
J
c
7
8
*
*
•
*
1
!
P.dUid City
P.dpid Creek
Cirl Sccut
I'.padoxbrooV
Jackion Spring
9/11
0.28
0 32
0.31
0.27
1:35
1 .09
1.06
1.17
1 .27
1.23
Sioux Falls
10/19
0.30
1.42
1 .27
1 .3 **
1.33
1.36
1 .45
1.45
1.48
Spearf i sh
Spe-irfish Canyon Cr.
Sccarfish Park Spr.
Dickey Wei 1
9/12
0.31
0.23
0.28
1.6
1 .46
1.40
1 .40
1 .44
Sturq! s
Well *1
3
Warren Creek
Well n
Volga
Well # 2
3
4
9/13
10/17
*
0.29
*
0.22
*
*
*
1.17
> 2.0
1 .20
1.98
1.14
2.03
1 .24
1 .06
1 .14
1.17
5
6
Watertown
Plant #1 (5 welIs)
Kampeska
Well #4
5
8
10/17
*
*
0.22
0.24
*
*
*
1.36
1.15
1.22
1.25
1.37
Webster
10/16
0.46
1.26
1.08
1.17
1.22
1.17
Woonsocket
Well 11
2
10/18
0.75
*
1.6
1.30
1.40
1.41
1.43
* No Raw Water Sampling Point
** Sioux Falls Health Department Laboratory
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12
SOUTH DAKOTA FLUORIDATION PROGRAM EVALUATION
TABLE IV
SUMMARY OF FLUORIDE CHECK SAMPLE ANALYSIS RESULTS 1/
Water Supply System
Check Samples 2/
Req'd/yr Rec'd/yr
Avg. <1
(mg/1)
.0 mg/1
{%)
Fluoride Analysis
1.0-1 .4 mg/1 >i
(%)
.4 mg/1 3/•
{%) ~\
Belle Fourche
24
33
1 .11
42
40
18
Bowdle 4/
12
12
1 .21
17
75
8
Box Elder 5/
12
Bri tton
12
23
1 .08
35
61
4
Cani stota
12
21
1 .18
33
38
29
Custer 4/
12
33
1 .17
21
61
18
Mobridge
24
20
1 .13
10
90
0
Parkston
12
16
1 .10
25
75
0
Philip 4/
12
19
1 .47
5
32
63
Pierre
24
103
1 .21
16
72
12
Rapid City 4/
52
51
1 .16
12
80
8
Sioux Falls
52
52
1 .18
4
94
2
Spearfi sh
24
22
0.98
45
46
9
Sturgi s
24
26
1 .07
27
69
4
Volga 4/
12
16
1.17
25
62
13
Watertown 3/
52
52
1 .24
10
86
4
Webster
12
22
1 .06
9
91
0
Woonsocket 4/
12
13
1 .29
8
61
31
Total 534 Avg. 20 67 13
]_/ Per 1972 Laboratory Records, South Dakota Dept. of Environmental Protection
2/ Number of Check Samples Required:
Population >10,000 - 1 per week
Population 3,000 - 10,000 - 2 per month
Population <3,000 - 1 per month
3/ One Sample Exceeded 2.4 mg/1 (2 x 1.2 mg/1 Optimum)
4/ Year of Record Taken as Sept. '72 - Aug. '73.
5/ Fluoridation Started 4/73. Only 3 Months of Record Available.
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13
less than 1.0 mg/1 and 13 percent were greater than 1.4 mg/1 fluoride.
Four of the installations (Belle Fourche, Canistota, Philip and
Spearfish) had less than 50 percent of their check sample results
within the recommended range.
The operating conditions observed during the time of the survey of the
eighteen fluoridation installations inspected are summarized as follows:
I. Analytical Control of the Fluoride Ion Level
Practices to analytically test and control the fluoride ion level
in the distribution system varied at each installation. The SPADNS
Method for fluoride ion analysis was used exclusively at each
installation and portable photometers (Hach DR Test Kits) were
employed at sixteen of the plants. No distillation procedures
to remove possible interferences in the analysis were followed.
Only seven (39 percent) of the plant operators or laboratory
personnel testing water samples for fluoride ion content conducted
the analysis within + 0.1 mg/1 of the duplicate samples analysis
performed by the EPA.
Daily finished water fluoride ion analysis, required in the State
Health Department Regulation 2.17, was conducted at only six (33
percent) of the installations and regular raw water fluoride ion
analysis was conducted at five (28 percent). The raw water
sources at three communities could not be sampled conveniently.
Analytical equipment, laboratory facilities and care for analytical
equipment were satisfactory at thirteen (72 percent) of the plants.
Records of the fluoridation operation, specified by Regulation 2.17,
were acceptable at only three (17 percent) of the installations surveyed.
-------
14
II. Fluoride Chemical Feed Equipment and Facilities
Fluoride chemical feed equipment, facilities and feed arrangements
were acceptable at nine (50 percent) of the plants visited.
Automatic solution preparation equipment, down flow saturators,
were used at thirteen of the water supplies visited; however, no
sand layer was included in the tanks which is essential in the down
flow saturator to prevent undissolved sodium fluoride from infiltrat-
ing into the solution feed reservoir. Another problem common with
the saturator installations was the injection of the saturated
fluoride solution into the water supply line at the same point
calcium hypochlorite solutions were fed. This practice will cause
a precipitate, plugging the injection lines.
Dry feeders and acid feed systems are not used extensively in the
State. Of the sixty-four fluoridation installations in South Dakota,
73 percent were saturators, 16 percent dry feed, 8 percent acid feed
and the remaining 3 percent were a combination of the three_ types.
Since May 1972 new acid feed systems were not being approved by the
State for safety reasons.
Twenty-three percent of the operators reported one or more inter-
ruptions in fluoridation of one or more days duration in the past
twelve months. Half of these interruptions were attributed to
mechanical problems with the feed equipment. In only one case was
the lack of chemical the cause of the interruption. Maintenance was
found satisfactory at fifteen (83 percent) of the facilities surveyed.
-------
15
. Fluoride Chemical Compound - Storage and Handling
Storage arrangements for the fluoride chemical compounds fed were
unsatisfactory at six (33 percent) of the installations surveyed.
The principle deficiency was the need to store the chemicals off
the floor to reduce possible damage from flooding and absorbance of
moisture. Three (17 percent) of the operators interviewed did not
have available suitable safety equipment to handle fluoride
chemical compounds. Disposal of the empty chemical shipping
containers was satisfactory at all the sites visited.
One community, Rapid City, was having difficulty feeding the
sodium silicofluoride recently purchased. The characteristics
and packaging of the product, received from a foreign producer,
varied from the product manufactured and sold as sodium silico-
fluoride in the U.S. When ordering fluoride chemical, the
community should specify that the product meet the AWWA Standard
for the chemical including material specifications, packaging
and marking.
-------
16
IV. Operator Training and Interest
A trained operator with a genuine interest in feeding fluorides
is essential to the satisfactory operation of a fluoridation
installation. Two (11 percent) of the facilities surveyed were
operated, by personnel not completely familiar with the fluoride
chemical feed equipment at their plants and one (6 percent) of
the operators was not adequately trained in the use of the fluoride
ion test equipment provided and the procedures to follow in
conducting fluoride ion analyses. The operators at four (22 percent)
of the plants visited did not favor feeding fluorides to public
water supply systems.
Nine of the eighteen selected installations were represented at
the Fluoride Determinations in Water training course presented in
Huron, S.D., November 1972. Generally better conditions were
observed at those supplies which had operators in attendance at the
course. Limited training in water fluoridation is also included
in the yearly short schools conducted by the State Water Hygiene
Program for operator certification.
-------
17
V. Surveillance
Frequent check samples of fluoride ion levels in the distribution
system and regular inspection visits to the water fluoridation
installation by State water supply surveillance personnel must
be conducted to assure the facility is operating satisfactorily.
The State requires fluoride check samples to be submitted to the
State Laboratory on a frequency depending on the population served
by the fluoridated community. Communities with populations greater
than 10,000, 1 sample per week; 3,000 - 10,000, 2 per month; less
than 3,000, one sample per month.
A review of the State Laboratory records for 1972 revealed the
required number of check samples had not been received from five
(28 percent) of the installations surveyed. Not one of the
installations had been visited in the past twelve months by a
representative of the State water supply surveillance agency.
Inspection visits to the eighteen systems surveyed averaged one
visit in 4.4 years. The Pierre installation had not been visited
since June 1958.
Figure 2, Operating Conditions At Selected Fluoridated Water Supply
Systems, summarizes the operating conditions observed at the installa-
tions inspected during the time of the survey. Conditions varied
at each facility and Table V, Adequacy Of Fluoridation At Selected
Fluoridated Water Supply Systems, summarizes the adequacy of the
operating conditions at each facility during the time of the survey.
-------
SOUTH DAKOTA FLUORIDATION PROGRAM EVALUATION
FIGURE 2
OPERATING CONDITIONS AT SELECTED FLUORIDATED WATER SUPPLY SYSTEMS
PARAMETER EVALUATED
Fluoride Ion Content In The Distribution System
Fluoride Ion Level 1.0 - 1.4 mg/1
Fluoride Ion Level <1.0 mg/1
Fluoride Ion Level >1.4 mg/1
Analytical Control Of The Fluoride Ion Level
0|^LU0RIDATE^ATER SUPP^ SYSTEMS SI^VEYED
t i I I 1 i | i
<0%)
-(56%)
(44%)
Operator Analysis +0.1 mg/1 EPA Value
Daily Finished Water Fluoride Ion Analysis
Regular Raw Water Fluoride Ion Analysis
Adequate Analytical Equipment & Facilities
Adequate Care For Laboratory Equipment
Adequate Records
Fluoride Chemical Feed Equipment And Facilities
-(28%)
-(33%)
¦(30%)
"{17%)
'(72%)
"(72%)
Adequate Feeding Equipment and Facilities
Adequate Feeding Arrangements
Feed Interrupted < 1-Day In Past 12-Months ]_/
Adequate Maintenance
Fluoride Chemical Compound - Storage And Handling
-(50%)
-(50%)
(77%)
(83%)
Adequate Storage Arrangements
Acceptable Safe Handling Provisions
Satisfactory Disposal Of Shipping Containers
Operator Training And Interest
"(67%)
'(83%)
Adequately Trained To Operate Feed Equipment
Knowledgeable Of Test Equipment & Procedures
Accepts And Interested In Fluoridation
'(78%)
¦(89%)
—(94%)
Survei1 lance
Check Samples To State
Installation Inspected
As
By
Required
State In
y
Past
12-Months
0%)
¦(72%)
17 Seventeen Installations Rated. Box Elder Started Fluoridating 4/73.
2/ Per 1972-73 Laboratory Records, South Dakota Dept. of Environmental Protection
CO
-------
SOUTH' DAKOTA FLUORIDATION PROGRAM EVALUATION
TABLE V
ADEQUACY OF FLUORIDATION AT SELECTED WATER SUPPLY SYSTEMS
PARAMETER FVALUATED
a>
o
X* *r~
O
CQ CO
c
rc
(J
i-
OJ
+J
3
•r- 1/1
l_
jQ J.
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2: Ci-
ty
u
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at
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LO
cn
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0)
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<1»
u
c
CO
c
o
o
Fluoride Ion Content In The Distribution System
Fluoride Ion Level 1.0 - 1.4 mg/1
Fluoride Ion Level <1.0 mg/1
Fluoride Ion Level >1.4 mg/1
Analytical Control Of The Fluoride Ion Level
Operator Analysis 0.1 nig/1 EPA Value
Daily Finished Water Fluoride Ion Analysis
Regular Raw Water Fluoride Ion Analysis
Adequate Analytical Equipment & Facilities
Adequate Care For Laboratory Equipment
Adequate Records
Fluoride Chemical Feed Equipment And Facilities
Adequate Feeding Equipment and Facilities
Adequate Feeding Arrangements
Feed Interrupted <1-Day In Past 12-Months
Adequate Maintenance
Fluoride Chemical Compound - Storage And Handling
Adequate Storage Arrangements
Acceptable Safe Handling Provisions
Satisfactory Disposal Of Shipping Containers
Operator Training And Interest
Adequately Trained To Operate Feed Equipment
Knowledgeable Of Test Equipment & Procedures
Accepts And Interested In Fluoridation
Survei11ance
Check Samples To State As Required ]_/
Installation Inspected By State In Past 12-Months
0
0.
0'
X
X
X
0
0
0
0
X
0
0
X
X
0
0
0
0
X
X
X
X
X
X
X
X
X
0
X
X
0
X
X
X
0
X
0
X
0
0
X
0
X
X
X
X
X
0
X
0
0
X
0
0
X
X
X
X
0
X
X
X
X
X
X
X
0
X
X
0
0
0
x
X
X
0
X
X
X
X
0
0
0
0
0
0
0
0
X
0
0
0
0
X
0
0
X
0
X
0
0
0
X
0
0
X
0
0
0
X
0
X
X
X
0
X
X
X
X
X
0
0
X
X
X
X
x
X
0
X
X
0
X
X
0
X
X
0
0
0
0
0
X
Y
0 '
X
X
X
0
X
X
0
0
X
X
0
0
0
X
X
0
0
0
2/
X
0
0
0
X
0
0
0
X
0
X
0
0
0
0
0
0
X
0
X
X
0
0
0
0
0
0
0
0
0
0
0
X
"0
X
0
X
0
0
0
X
0
0
X
0
X
0
0
0
0
0
0
0
0
0
0
0
X
0
0
X
X
0
0
0
0
0
0*
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
X
X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
a
X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
X
0
X
0
0
0
0
0
0
0
0
0
0
X
0
0
0
0
0
0 '
X
0
X
X
0
0
X
0
X
0
0
0
0
0
X
X
X
X
X
X
X
X
X
X
X
X
\
X
X
X
A
0 - Satisfactory; X - Unsatisfactory
1/ Per 1 972-73 Laboratory Records, South Dakota Dept. 0i Environ-ien.a 1 Pt o tec on^
// fluoridation '> Listed ¦•''73. :io Iiiccrrupcujiis In Feed To Hale Oi .-.jivey, 9/11/7.1.
-------
20
Conclusions anc! Recommendations
1. Sixty-four public water supply systems in the State of
South Dakota were fluoridating in September 1973, serving an
estimated population of 327,900 (1970 Census). Twenty-seven
communities, population 15,000 were using water sources containing
natural fluorides within the recommended range (0.9 - 1.7 mg/1).
Of the 276 reported public water supplies in the State, ninety-one
(33 percent) were fluoridating or using one or more water sources
containing natural fluorides within the recommended range.
Recommendation:
The South Dakota Department of Environmental Protection should
promote the fluoridation of all public water supplies in the
State not fluoridating or not containing dentally significant
concentrations of natural fluorides. In communities where no
public water supply systems exist, school fluoridation in that
community should be considered if the available water sources do
not contain natural fluorides of 0.9 mg/1 or higher.
-------
21
2. Sixty public water supplies in the State were reported using
one or more water source containing natural fluorides greater
than 2.4 mg/1 or two times the recommended optimum level of
1.2 mg/1.
Recommendation
When the natural fluoride ion content in a public water supply
exceeds two times the optimum, the following should be considered
so the finished water will have a fluoride ion content within
the limits recommended by the State: blending of water containing
high levels of fluoride ion with a low natural fluoride water;
development of an alternate source of water; or defluoridation of
the water source.
3. Ten. (56 percent) of the eighteen fluoridated water supply systems
surveyed evidenced a fluoride ion content in the distribution system
within the recommended limits of 1.0-1.4 mg/1 fluoride. Only sixty-
seven percent of the 534 fluoride check samples received by the
State laboratory in the past year from the supplies surveyed were
within the 1.0-1.4 mg/1 range.
Recommendation
The South Dakota Department of Environmental Protection should more
vigorously enforce their recommended fluoride standards at all fluoridated
water supplies since a reduction of as little as 0.2 mg/1 below the
recommended optimum level can reduce the benefits by 50 percent.
-------
22
4. Only seven (39 percent) of the plant operators or laboratory
personnel testing water samples for fluoride ion content conducted
the analysis within + 0.1 mg/1 of the sample results analyzed by
the EPA. Daily finished water fluoride ion analysis required in
the State Health Department Regulation 2.17 was conducted at six
(33 percent) of the installations and the source of raw water was
analyzed on a regular b&sis at five (28 percent). Records were
satisfactory at only three (17 percent) of the plants.
Recommendation
The South Dakota Department of Environmental Protection should
require the operators of all fluoridation installations to conduct
fluoride ion analyses according to Standard Methods to within
+0.1 mg/1 of the value reported on the State check sample. Daily
finished water fluoride ion analysis, regular raw water fluoride
ion analysis, adequate laboratory equipment and care of equipment,
and complete records on the fluoridation operation should be
enforced at all fluoridation installations.
5. Fluoride chemical feed equipment, facilities and feed arrangements
were satisfactory at nine (50 percent) of the plants surveyed.
Four (23 percent) of the installations reported one or more
interruptions in the fluoridation operation of one or more days
duration in the past twelve months and maintenance was less than
satisfactory at three (17 percent) of the facilities.
-------
23
Recommendation
The South Dakota Department of Environmental Protection should
develop specific regulations for the installation of fluoridation
equipment in the State, thoroughly review all proposed installations
before the operation is approved, and assist the operator as needed
during the "start-up" period.. All interruptions should be required
to be reported to the State. A preventive maintenance program
should be established for each facility and closely followed for the
installation to receive continued approval for operation.
6. Fluoride chemical storage arrangements were inadequate at six
(33 percent) of the installations and three (17 percent) of the
operators interviewed did not have available suitable safety equipment
to handle the fluoride compounds used. Variation in chemical
characteristics of the fluoride compound recently purchased at
Rapid City was causing problems in feeding fluorides at the plant.
Recommendation
The South Dakota Department of Environmental Protection should
promulgate regulations for storage and handling fluoride chemical
compounds used in water fluoridation in the State, and should provide
to all water plant operators feeding fluorides, training in safe
handling practices. Communities ordering fluoride chemicals should
specify that the product meet the AWWA Standard for the chemical
including material specifications, packaging and marking.
-------
24
7. A trained operator with a genuine interest in feeding fluorides
is essential to the satisfactory operation of a fluoridation
installation. Training deficiencies were noted in the operator's
knowledge of his fluoride feed equipment and his acquaintance
with the equipment and procedures used in conducting fluoride ion
analysis. Four (22 percent) of the operators interviewed did not
favor feeding fluorides to public water supply systems.
Recommendation
The South Dakota Department of Environmental Protection should
expand their training program to include training in fluoride feed
equipment operation and maintenance and fluoride determinations in
water for the operators of all fluoridated water supply systems. The
benefits of water fluoridation and the importance of maintaining
an optimum level of fluoride ion in the distribution system at all
times should be stressed. Satisfactory completion of the training
should be a mandatory requirement of each plant operator for
approval of his installation to feed fluorides.
8. Surveillance of each water fluoridation installation must be on a
regular, continual basis to assure the facility is operating
satisfactorily. Five (28 percent) of the operators interviewed had
I
not submitted to the State Laboratory in the past year the required
number of check samples for fluoride ion analysis. Not one of the
installations surveyed had been visited in the past year by a
representative of the State water supply surveillance agency.
-------
25
Recommendation
The South Dakota Department of Environmental Protection should
enforce their regulations for the submission of fluoride check
samples to the State Laboratory. Inspection visits to each
fluoridation installation in the State should be scheduled once
each year. Interruptions in the fluoridation feed operations at
any plant or any variation in check sample results greater than
+ 0.1 mg/1 should be investigated. All plants employing new
operating personnel placed in charge of the fluoridation operation
should be visited immediately to assure the new operator has been
adequately trained.
9. The proven benefits in dollars derived from fluoridation to prevent
dental caries for the population in South Dakota presently served
by fluoridated water are estimated to be $3.0 million annually.
The annual cost to the sixty-four communities to fluoridate their
water is estimated at $52,500 and the annual cost to the State
for implementing a satisfactory fluoridation program is estimated
at $50,00C, giving a benefit cost ratio to the State of 29 to 1.
Recommendation
The Soutn Dakota Department of Environmental Protection should
supplement their existing fluoridation program effort by the
assignment to this activity of one additional engineer full time
with the necessary travel funds and laboratory support.
-------
26
APPENDICES
A. South Dakota Fluoridation Law
B. Letter dated January 18, 1973, from Charles E. Carl, Director,
Division of Sanitary Engineering and Environmental Protection,
South Dakota Department of Health, to John A. Green, Regional
Administrator, Environmental Protection Agency, Region VIII,
requesting evaluation of the South Dakota Fluoridation Program.
C. Fluoridation of Water, SDCL Chapter 34-24 A.
D. Fluoridation of Municipal Water Supplies, South Dakota State
Department of Health Regulation 2.17.
E. Natural Fluoride Levels, South Dakota Community Water Supply
Systems.
F. Water Supply Systems Containing Excessive Levels of Fluorides.
G. Fluoridation Benefits in South Dakota - Calculations.
H. Questionnaire used in the South Dakota Fluoridation Survey.
-------
Appendix A
SOUTH DAKOTA FLUORIDATION LAW
Approved March 25, 1969
AN ACT ENTITLED, AN ACT RELATING TO PUBLIC HEALTH; REQUIRING FLUORIDATION OF
SOUTH DAKOTA MUNICIPAL WATER SUPPLIES; PRESCRIBING THE POWERS AND DUTIES OF THE
SOUTH DAKOTA STATE DEPARTMENT OF HEALTH IN RELATION THERETO.
Be It Enacted by the Legislature of the State of South Dakota:
For the purpose of promoting Public Health through prevention of tooth decay any
person, firm, corporation or municipality having jurisdiction over a municipal
water supply, whether publicly or privately owned or operated, shall control the
quantities of fluoride in the water so as to maintain a minimum fluoride content
prescribed by the South Dakota State Department of Health. The South Dakota
State Department of Health shall promulgate rules and regulations relating to the
fluoridation of public water supplies which shall include, but not be limited to
the following: (1) the means by which fluoride is controlled; (2) the methods of
testing the fluoride content; and (3) the records to be kept relating to fluori-
dation. The State Department of Health shall enforce the provisions of the
section. In so doing it shall require the fluoridation of water in all municipal
water supplies serving a population of 3,000 or more by July 1, 1970, serving a
population of 1,000 to 3,000 by July 1, 1971 and serving a population of 500 to
1,000 by July 1, 1972. The State Department of Health shall not require the
fluoridation of water in any municipal water supply where such water supply in
the state of nature contains sufficient fluorides to conform with the rules and
regulations of such Department,
-------
55?iJS
Pakcia
Jltate 39?partment of £H?alt[]
ROBERT H HAYES. MO..
^ierre
January 18, 1973
In Reply II-A
Refer to:- South Dakota Fluoridation
Program Evaluation
John A. Green
Regional Administrator
Environmental Protection Agency
900 Lincoln Tower Building
1860 Lincoln Street
Denver, Colorado 80203
Dear Mr. Green:
This office has the responsibility for enforcement of the State Fluoridation
Law which requires fluoridation of all public water supplies in South Dakota
above 500 population. Eighty-four cities with a total population of 342,000
are involved in the State Fluoridation Program. Because of dental health
aspects of fluoridation, the enforcement and surveillance of this State Law
is an important part of the Water Hygiene Program in South Dakota.
We expect to have all cities in compliance with the Law in about four months.
With compliance, we would then like to have an outside agency evaluate the
South Dakota Fluoridation Program.
It is therefore requested that the Environmental Protection Agency through
the Division of Water Hygiene conduct an evaluation of the South Dakota
Fluoridation Program. We would suggest a date sometime during the fall
of 1973.
Very truly yours
Charles E. Carl, Director
Division of Sanitary Engineering
and Environmental Protection
CEC:ks
-------
E2.39R/100/3-70
Appendix C
Chapter 34-24A
FLUORIDATION OF WATER
34-24A-1. Duty of control of fluoride content in municipal water supply.--
For the purpose of promoting public health through prevention of tooth decay any
person, firm, corporation or municipality having jurisdiction over a municipal
water supply, whether publicly or privately owned or operated, shall control the
quantities of fluoride in the w^ter so as to maintain a minimum fluoride content
prescribed by the South Dakota state department of health.
34-24A-2. Rules and regulations relating to fluoridation of water supplies.—
The South Dakota state department of health shall promulgate rules and regulations
relating to the fluoridation of public water supplies which shall include, but not
be limited to the following:
(1) The means by which fluoride is controlled;
(2) The methods of testing the fluoride content; and
(3) The recordr. to be kept relating to fluoridation.
34-24A-3. Enforcement of fluoridation requirements—Time for fluoridation
of municipal water supplies—Exemption from fluoridation requirement.--The state
department of health shall enforce the provisions of § 34-24A-1 and § 34-24A-2.
In so doing it shall require the fluoridation of water in all municipal water
supplies serving a population of three thousand or more by July 1, 1970, serving
a population of one thousand to three thousand by July 1, 1971 and serving a
population of five hundred to one thousand by July 1, 1972. The state department
of health shall not require the fluoridation of water in any municipal water
supply where such water supply in the state of nature contains sufficient fluorides
to conform with the rules and regulations of such department.
This statute is reproduced in accord with the "Executive Order Establishing
a Procedure for Licensing Reprints of the South Dakota Compiled Laws and Its
Supplements", Governor's office, dated October 30, 1969; and the approval of the
State Board of Finance on December 15, 1969, for reprinting the statutes concern-
ing the South DaKOta State Department of Health providing that the editorial
matter be omitted.
Cross references, references to Attorney General's opinions, and other
editorial material included in the statutes are copyrighted. Those persons
interested in these materials should refer directly to the printed South Dakota
Compiled Laws.
Reproduced and distributed by the Division of Sanitary Engineering, State
Department of Health.
-------
. -fw/ y*JKj ; x. / / \j
Appendix D
SOUTH DAKOTA STATE DEPARTMENT OF HEALTH
FLUORIDATION OF MUNICIPAL W/TER SUPPLIES
Regulation 2.17
Effective January 27, 1970
This regulation is issued by the South Dakota State Department of Health under the
authority act forth in SDCL Chapter 34-24A and SDCL Chapter 34-1 and In accordance
v;ifh the procedures set torth in SDCL Chapter 1-2.6.
The following members, being a quorum for the transaction of business, completed
voting by mail December 30, 1969:
L. P. Mills, D.O., Platte
John Venners, D.V.M., Plankinton
Walter II. Morgans, D.D.S., Aberdeen
Mrs. Margaret Cashman, P.N., Sioux Falls
Vere Larsen, Alr.es ter
Allen Bronson, D.C., Jefferson
Dale Garris, Chamberlain
Robert H. Quinn, M.D., Sioux Falls
IT WAS VOTED TO ADOPT THE REGULATION AS FOLLOWS:
2.17 FLUORIDATION OF MUNICIPAL WATER SUPPLIES
2.17.1 Definitions:
2.17.1.1 Municipal Water Supplies - shaLl mean any i?ater supply
operated by a person, firm, corporation, municipality,
or sanitary district serving a population of 300 or more
people.
2.17.1.2 State Health Officer - shall mean the duly appointed State
Health Officer of the State Department of Health or his
authorized representative.
2.17.1.3 State Department of Health - Department created by SDCL
Chapter 34-1.
2.17.1.4 Milligrams per liter - a method of expressing analytical
results. For purposes of the regulation milligrams per
liter (mg/1) is equivalent to parts per million (ppm) by
we i giit.
2.17.2 Written approval is required by the South Dakota Department of Health
of proposals for addition of fluoride ion to municipal water supplies.
Plans and specifications shall be submitted as prescribed by Regulation.
No. 2.1.
-------
-2-
2.17.3
2.17.4
2.17.5
2.17.6
Fluoridation installations other than on municipal supplies are to be
in compliance with this regulation.
A variance to this requirement may be allowed by the State Health
Officer for installations costing less than $1,000.
Where the average natural fluoride ion content of the water from any
source for a municipal water supply is less than 0.9 mg/1, equipment
shall be provided arid operated to adjust the fluoride ion concentration
in the range of 0.9 mg/1 to 1.7 mg/1, with an average level of 1.2 mg/1.
Those municipal water supplies with fluoride ion concentrations in
excess of 1.7 mg/1 should consult with the South Dakota Department of
Health relative to procedures for reducing the fluoride ion content
to an optimum amount.
The chemical feeder apparatus for introducing fluoride ion into the
water supply shall be constructed, installed, and operated in accord-
ance with the standards of the State Department of Health.
Testing equipment shall be available for determing the fluoride content
at each installation. The fluoride content shall be determined each
day on a representative sample of fluoridated water.
A variance to this requirement may be allowed by the State Health
Officer upon request and submission of evidence that other testing
procedures are satisfactory.
Representative samples shall be collected from the distribution system
and submitted to the State Department of Health Laboratory in Pierre
for testing - in accord with the follox^ing schedule:
(a) Population over 10,000 - one sample per week.
(b) Population of 3,000-10,000 - two samples per month (one
sample the first week of the month and the second sample
the third week of the month).
(c) Population less than 3,000 - one sample each month.
Daily records of the fluoride content of the distribution system shall
be maintained by the water system owners or their representatives.
These records shall show the amount of fluoride chemical fed to the
system, fluoride test results, amount of water pumped, and any other
pertinent information as required by the State Department of Health.
These records are to be available for review by the State Health
Officer.
State Health Officer
-------
Apperidl'. t
natural Fluoric? I eve Is
South Dakota Conmunity W.tler Supply Systems (a)
Water Supply System
Marion
Ma n s f i e 1 d
He Intosh
Meadow
Mellette
Menno
Midland
Miller
Mission Hill
Morri stown
Mound City
Mount Vernon
flewel 1
North Sioux City
l.orthvi 1 le
Oacora
Oldhan
Oaida
Orient
Pierpont
PIankinton
Platte
Presho
Pukwana
Quinn
Rairona
Rayrond
Redfie1d
Ree Heights
Rellance
Roc khan
Roscoe
Roswel1
Sinai
Stickney
Stratford
Tabor
Tolstoy
Tripp
Tn 1 are
Utica
Viborg
Vilas
Virgil
Vivian
Vol in
Wall
Wentworth
Wesslngton
Wetonka
White Lake
Wolsey
Worthing
Yale
1970
Population
844
130
563
S
199
796
270
2148
161
144
164
398
664
860
119
215
244
785
131
241
613
1351
922
208
105
227
114
2943
183
204
60
398
32
147
421
106
388
99
851
211
89
622
33
43
190
157
786
196
380
31
395
436
294
148
Natural Fluoride Level, mg/1
(b)
0.9-1.7 1.8-2.4 >2.4
Natural Fluoride Level, mg/1
1970
(b)
Water Supply System
Population
0.9-1.7 1.8-2.4 >2.4
Agar
156
X
A1exandria
598
X
A1pena
307
X
Amherst
75
X
Armour
S'5
X
Ashton
137
X
Bancroft
48
X
Belvidere
96
X
Bison
406
X
Brentford
94
X
Broadland
45
X
8ryant.
502
X
Canova
204
• X
Canton
2665
X
Carthage
362
X
Cavour
134
X
Chancel lor
220
X
Claremont
214
X
Colome
375
X
Conde
279
X
Cors ica
615
X
Cresbard
224
X
Crooks Sanitary District
202
X
Del mont
260
X
Doland
430
X
Draper
200
X
Dupree
523
X
Eagle Butte
503
X
Edgemont
1174
X
Esmond
19
X
Ethan
309
X
Eureka
1547
X
Ferney
4 7
X
Forestburg
105
X
Frankford
192
X
Fur i tda 1 e
74
X
Gann Valley
75
X
Geddles
308
X
Gettysburg
1915
X
Groton
1021
X
Hi tclicock
150
X
Houghton
102
X
Howard
1175
X
Ipswich
1187
X
Iroquois
375
X
Kadoka
815
X
Kimbal1
825
X
Lake Preston
812
X
Lane
94
X
Langford
328
X
Lenmton
1997
X
Leola
787
X
Lestervi1le
181
X
Letcher
201
X
(a) Water supply systems using one or mce water sources containing na'.ural fluorides of 0.9 mo/1 or higher (State Records, 1972)
(b) Two tim»« the Std'e reconoended optimum 1«ve1 of 1.2 mg/1
-------
Appendix F
SOUTH DAKOTA FLUORIDATION PROGRAM EVALUATION
Water: Supply Systems Containing Excessive Levels of Fluorides *
6 »
* Water supply systems using one or more sources of water containing
natural fluorides greater than 2.4 mg/1 (1972 State Records)
-------
APPENDIX G
FLUORIDATION BENEFITS IN SOUTH DAKOTA - CALCULATIONS
Population Served by Fluoridated Water - 327,900
(1970 Census for communities reported fluoridating)
Average Annual Cost to Communities Fluoridating - $0.16/capita/year
("Fluoridation of Public Water Supplies" -
New York State Department of Health)
Total Annual Cost of Fluoridation in South Dakota
to Communities Fluoridating:
327,900 X $0.16 = $52,500/year
Average Annual Benefit of Fluoridation to Communities Fluoridating -
$58/yr/dollar spent on fluoridation
("The Economics of Fluoridation" - DDH, PPB #31, USPHS)
52,500 X $58 = $3,045,000/yr or $3.0 X 106
Total Annual Cost to the State for Fluoridation Surveillance -
1.5 man years + travel @ $30,000/man yr = $45,000
Laboratory support -
64 installations, 25 samples/installation, $3.00/sample
64 X 25 X $3.00 = $ 4,800
TOTAL $49,800 or $50,000
Benefit Cost Ratio:
Annual Benefit of Fluoridation = 3.0X106 or 29:1
Annual Cost to Communities + Annual Cost to State $52,500+$50,000
-------
Appendix H
SOUTH DAKOTA FLUORIDATION SURVEY
V,Liter System:
Population Served:
Date Fluoridation Started:
Source of Supply:
Trca tment:
t'.l uo r i.de Ana Lys i.s :
Raw Water:
Fluoridation Equipment -
Manufacturer:
Type:
Model:
Location:
Point of Application:
Condi l:i' ip of !v| 11 i pihe:;! :
OpL'.rat i rin;i ! 1*r'>h 1 em:.-;:
Over! ee.c'i ny Safeguards :
Planned Improvements:
Remarks:
Average Flow:
Finished Water
-------
Fluoride Compound -
Chemical:
Source:
Form of Shipment
Storage Facilities:
Ounn t i.ty Used :
Safety Provisions:
Disposal of Containers
Remarks:
Control of Fluoridation -
Frequency of Sampling:
Raw Water:
Sampling Point:
Test Method:
Test Instrument:
Adequacy
Condi t i on
Records:
Calculated
Lab
In tertrup tions :
Remarks :
-------
3
Operator Qualifications -
Experience: Classification:
'J' r a i n i n g :
Interest:
Remarks:
Surveillance -
Chock Samples:
Last Visi.t by State:
Ava i. I al> i I. i. ty of Tec.lni i ca I. Assistance:
Remarks:
Comments -
-------
SOUTH DAKOTA FLUORIDATION PROGRAM EVALUATION
Table 1
Fluoridated Water Supply Systems In South Dakota
Water Supply System
Location Date
(County) Fluoridation Started
1970 Census
Population
Water Supply System
Location Date
(County) Fluoridation Started
1970 Census
Population
Aberdeen
Belle Fourche
Beresford
Bowdle
Box Elder
Brandon Water Co.
Bridgewater
Britton
Brookings
Burke
Canistota
Castlewood
Centerville
Chamberlain
Clark
Brown
Butte
Union
Edmunds
Pennington
Minnehaha
McCook .
Marshall
Brookings
Gregory
McCook
Hamlin
Turner
Brule
Clark
!
2/51
1/71
7/71
7/72
4/73
1/71
10/72
6/71
12/61
5/72
10/72
4/73
7/73
7/71
11/71
26,476
4,236
1,655
667
607
1,431
633
1,465
13,717
892
636
523
910
2,626
1,356
Lead - Deadwood
Madison
Martin
McLaughlin
Mil bank
Mitchell
Mo bridge
Murdo
Parker
Parkston
Philip
Pierre
Rapid City
Rapid Valley Water
Service Company
Lawrence
Lake
Bennette
Corson
Grant
Davidson
Walworth
Jones
Turner
Hutchinson
Haakon o.
Hughes
Pennington
Pennington
10/70
5/70
11/71
10/72
4/68
11/54
3/52
9/72
1/69
1/72
5/72
8/68
8/70
7/71
5,420
2,409
6,315
1,248
863
3,727
13,425
4,545
865
1,005
1,611
983
9,699
43,836
1,800
Clear Lake
Deuel
11/71
1,157
Salem
McCook
3/71
1,391
Custer
Custer
8/71
1 ,597
Scotland
Bon Honrrie
8/72
9o4
Dell Rapids
Minnehaha
8/71
1 ,991
Selby
Walworth
5/72
957
DeSmet
Kingsbury
10/71
1,336
Sioux Falls
Minnehaha
10/70
72,488
Estelline
Hamli n
10/72
624
Sisseton
Roberts
4/72
3,094
Faith
Meade
6/72
576
Spearfish
Lawrence
11/70
4,661
Flandreau
Moody
9/71
2,027
Springfield
Bon Home
6/67
1,566
Fort Pierre
Stanley
• 3/72
1 ,448
Sturgis
Meade
12/70
4,536
Freeman
Hutchinson
1/72
1 ,357
Vermillion
Clay
10/51
9,128
Gregory
Gregory
7/69
1 ,756
Volga
Brookings
4/72
982
Hartford
Minnehaha
1/73
800
Wagner
Charles Mix
7/71
1,655
Highmore
Hyde
1/72
1,173
Watertown
Codington
9/53
13,388
Hosmer
Edmunds
4/57
437
Webster
Day
1/70
2,252
Hot Springs
Fall River
10/70
4,434
Wessington Springs
Jerauld
5/66
1,300
Hoven
Potter
7/72
671
Winner
Tripp
8/70
3,789
Huron
Beadle
9/56
14,299
Woonsocket
Sanborn
5/72
852
McCook Lake
Union
10/72
806
Yankton
Yankton
11/70
11,919
Lake Andes
Charles Mix
1/72
948
-------
SOUTH DAKOTA FLUORIDATION PROGRAM EVALUATION
TABLE II
FLUORIDATED WATER SUPPLY SYSTEMS SELECTED FOR STUDY
Population Avg. Use Fluoride Type of Analysis Test
Water Supply System Served Source of Supply (MGD) 1/ Compound Feeder Method Equipment
Belle Fourche
4,500
Infiltration Gallery
0.5 W
2.5 S
VT
PS-1
S
T-
Bowdle *
700
5 - Wells
0.05 W
S
T-
Well #1
0.17 S
VT
PS-2
2
VT
PS-2
3 & 4
VT
PS-2
6
VT
PS-2
Box Elder
1,700
2 - Wells
0.06 W
S
T-
Well #1
0.08 S
VT
PS-3
2
VT
PS-3
Britton
1,450
White Lake
0.16 W
0.28 S
VA
P-l
s
T-'
Canlstota *
600
2 - Wells
0.05 W
0.05 S
VT
PS-2
s
T-
Custer
1,800
3 - Wells
0.15 W
s
T-"
Well #2
0.25 S
VT
PS-3
4
VT
PS-3
5
VT
PS-3
Mobridge
4,900
Oahe Reservoir
0.30 W
1.50 S
VT
V-l
s
T-
Parkston *
1,600
2 - Wells
0.18 W
0.30 S
VT
PS-4
s
T-'
Philip *
1,400
Lake Waggoner & Artesian Well
0.12 W
0.30 S
VT
PS-5
s
T-
Pierre
9,800
8 - Wells
1.70
s
T-'
Well #1
VA
P-l
2
VA
P-l
3
VA
P-l
4
VA
P-l
5
VA
P-l
6
VA
P-l
7
VA
P-l
8
49,000
VA
P-l
Rapid City *
Rapid Cr., 2-Infiltration
7.30
s
T-
Rapid Creek
Galleries, Jackson Spr.
VS
V-2
Girl Scout
VS
V-3
Meadowbrook
VS
V-3
Jackson Spring
VS
V-3
Sioux Falls *
80,000
30 - Wells & Sioux R.
11.0 W
18.n S
VS
G-l
s
T-;
Spearfish
6,400
Spearfish Cr., .Spearfish Spr.,
1.1 u
s
T-
Spearfish Canyon -Cr.
1 - Well
2.4 S
VT
PS-1
Spearfish Park Spr.
VT
PS-1
Dickey Well
VT
PS-1
Sturgis
5,000
3 - Wells, Warren Cr.
0.40 W
s
T-
Well #1 & 3
0.98 S
VT
PS-5
Warren Creek
VT
PS-1
Well n
VT
PS-5
Volga *
1,000
5 - Wells
0.20
s
T-'
Well #2
VT
PS-6
3
VT
PS-7
4
VT
PS-6
5
VT
PS-2
6
VT
PS-2
Watertown
14,600
8 - Wells, Lake Kampeska
2.0
s
T-;
Plant #1 [5 wells)
VS
V-2
Kampeska
VS
V-3
Well #4
VT
PS-2
5
8
VT
VT
PS-2
PS-4
Webster *
2,200
5 - Wells
0.16 W
0.35 S
VT
PS-5
s
T-'
Woonsocket *
800
2 - Wells
0.04 W
s
T-'
Well #1
0.07 S
VT
PS-2
Fluoride Compound Analysis Method
VA - Fluosiliclc Acid 5 - Spadns
VS - Sodium Silicofluoride
VT - Sodium Fluoride
Test Equipment
T-l Photometer - Hach DR
T-2 Spectrophotometer - B & L Spectronlc 20
T-3 Spectrophotometer - Hach DR/2
* Representative Attended Fluoride Determinations 1n Water
Training Course, Huron, S.C., Nov. 28-30, 1972.
Type of Feeder
G-l Gravimetric - BIF 31-12 Loss-1n-We1ght
P-l Diaphram Pump - W & 1 A-747
V-l Volumetric - BIF 50-A Rotating Disk
V-2 Volumetric - W & T A-690 Screw Type
V-3 Volumetric - W & T A-378 Roll Type
PS-1 Diaphram Pump - W & T A-747, Saturator
PS-2 Diaphram Pump - W & T 94-100, Saturator
PS-3 Diaphram Pump - W 8 T A-748, Saturator
PS-4 Diaphram Pump - W & T A-416, Saturator
PS-5 Diaphram Pump - W & T A-745, Saturator
PS-6 Diaphram Pump - F & P 71 R 2000, Saturator
PS-7 Diaphram Pump - PCP Models, Saturator
1/ W-Winter; S-Sunmer
y Supply Not Fluoridated
-------
Appendix E
Natural Fluoride Levels
South Dakota Corniunity Hater Supply Systems (a)
Natural Fluoride Level, mg/1
Natural Fluoride Level, mg/1
1970
(b)
1970
(b)
Water Supply System
Population
0.9-1.7 1.8-2.4 >2.4
Water Supply System
Population
0.9-1.7 1.8-2.4 >2.4
Agar
156
x
Marion
844
X
Alexandria
598
x
Mansfield
130
X
Alpena
307
X
Mc Intosh
'•> 563
X
Amherst
75
X
Meadow
8
X
Armour :
925
X
Mel lette
199
X
Ashton
137
X
Menno
796
X
Bancroft
48
X
Midland
270
X
Belvidere
96
X
Miller
2148
X
Bison
406
X
Mission Hill
161
X
Brentford
94
X
Morristown
144
X
Broadland
45
X
Mound City
164
X
Bryant
502
X
Mount Vernon
398
X
Canova
204
X
Newel 1
664
X
Canton
2665
X
North Sioux City
860
X
Carthage
362
X
Northville
119
X
Cavour
134
X
Oacoma
215
X
Chancellor
220
X
Oldham
244
X
Claremont
214
X
Onida
785
X
Colome
375
X
Orient
131
X
Conde
279
X
Pierpont
241
X
Corsica
615
X
Plankinton
613
X
Cresbard
224
X
Platte
1351
X
Crooks Sanitary District
202
X
Presho
922
X
Delmont
260
X
Pukwana
208
X
Doland
430
X
Quinn
105
X
Draper
200
X
Ramona
227
X
Dupree
523
X
Raymond
114
X
Eagle Butte
503
X
Redfield
2943
X
Edgemont
1174
X
Ree Heights
183
X
Esmond
19
X
Reliance
204
X
Ethan
309
X
Rockham
60
X
Eureka
1547
X
Roscoe
398
X
Ferney
47
X
Roswell
32
X
Forestburg
105
X
Sinai
147
X
Frankford
192
X
Stickney
421
X
Furitdale
74
X
Stratford
106
X
Gann Valley
75
X
Tabor
388
X
Geddles
308
X
Tolstoy
99
X
Gettysburg
1915
X
Tripp
851
X
Groton
1021
X
Tulare
211
X
Hitchcock
150
X
Utica
89
X
Houghton
102
X
Viborg
622
X
Howa rd
1175
X
Vilas
33
X
Ipswich
1187
X
Virgil
43
X
Iroquois
375
X
Vivian
190
X
Kadoka
815
X
Vol in
157
X
Kimball
825
X
Wall
786
X
Lake Preston
812
X
Wentworth
196
X
Lane
94
X
Wessington
380
X
Langford
328
X
Wetonka
31
X
Lemmon
1997
X
White Lake
395
X
Leola
787
X
Wolsey
436
X
Lesterville
181
X
Worthing
294
X
Letcher
201
X
Yale
148
X
(a) Water supply systems using one or more water sources containing natural fluorides of 0.9 mg/1 or higher (State Records, 1972)
(b) Two times the State recorrmended optimum level of 1.2 mg/1
-------
SOUTH DAKOTA FLUORIDATION PROGRAM EVALUATION
TABLE III
ANALYSIS OF SAMPLES FROM SELECTED FLUORIDATED WATER SUPPLY SYSTEMS
Water Supply System
Date
of
Sample
Fluoride Content
. mq/1
Raw
Water
Check Sample
Operator State EPA
Distribution System
Belle Fourche
9/13
0.25
>2.0 2.88 2.90
1.76 2.90
Bowdle
10/15
1.4 1.85 1.80
1.45 1.80
Well #1
2
0.34
3 & 4
6
Box Elder
9/11
1.6 1.71 1.70
1.55 1.70
Well #1
0.49
2
0.69
Britton
10/16
0.24
1.3 1.45 1.43
1.47 1.50
Canistota
10/18
, ,0.55
2.0 1.51 1.58'
1.28 1.27
Custer
9/14
1.2 1.30
1.23 1.23
Well #2
4
C
*
~
~
1.20 1.23
3
Mobridge
10/15
0.52
1.5 1.35 1.24
1.33 1.14
Parkston
10/18
0.58
1.62 1.19 1.28
1.28 1.28
Philip
9/14
1.7 2.20
1.49
Lake Waggoner
0.45
1.47 1.49
Artesian Well
1.98
Pierre
9/10
1.31 1.22
1.28 1.22
Well #1
2
3.
4
5
*
+
~
~
~
1.38 1.37
1.22 1.37
6
7
8
Rapid City
9/11
*
~
*
1.35 1 .09 1.06
1.17 1.23
Rapid Creek
0.28
1.27
Girl Scout
0.32
Meadowbrook
0.31
Jackson Spring
0.27
Sioux Falls
10/19
0.30
1.42 1.27 1.33
1.45 1.48
1.3 ** 1.36
1 .45
Spearfish
9/12
1.6 1.46 1.40
1.40 1.44
Spearfish'Canyon Cr.
0.31
Spearfish Park Spr.
0.23
Dickey Well
0.28
Sturgis
9/13
1.17 1.20 1.14
1.24 1.14
Well #1
*
3
0.29
Warren Creek
*
Well #2
0.22
Volga
10/17
> 2.0 1.98 2.03
1.06 1.17
Well #2
~
3
~
4
~
5
*
6
~
Watertown
10/17
1.36 1.15 1.22
1.25 1.37
Plant #1 (5 wells)
0.22
Kampeska
0.24
Well #4
~
5
8
~
~
Webster
10/16
0.46
1.26 1-08 1.17
1.22 1.17
Woonsocket
10/18
1.6 1-30 1.40
1.41 1.43
Well #1
0.75
2
~
* No Raw Water Sampling Point
** Sioux Falls Health Department Laboratory
-------
SOUTH DAKOTA FLUORIDATION PROGRAM EVALUATION
TABLE V
ADEQUACY OF FLUORIDATION AT SELECTED WATER SUPPLY SYSTEMS
PARAMETER EVALUATED
Belle Fourche
Bowdle
Box Elder
Britton
Canistota
Custer
Mobridge
Parkston
Philip
Pierre
Rapid City
Sioux Falls
Spearfish
Sturgis
Volga
Watertown
Webster
Woonsocket
Fluoride Ion Content In The Distribution System
Fluoride Ion Level 1.0 - 1.4 mg/1
X
X
X
X
0
0
0
0
X
0
0
X
X
0
0
0
0
X
Fluoride Ion Level <1.0 mg/1
Fluoride Ion Level >1.4 mg/1
X
X
X
X
X
X
X
X
Analytical Control Of The Fluoride Ion Level
Operator Analysis +_ 0.1 mg/1 EPA Value
X
X
0
X
X
0
X
X
X
0
X
0
X
0
0
X
0
X
Daily Finished Water Fluoride Ion Analysis
X
X
X
X
X
0
X
0
0
X
0
0
X
X
X
X
0
X
Regular Raw Water Fluoride Ion Analysis
X
X
X
X
X
X
X
0
X
X
0
0
0
X
X
X
0
X
Adequate Analytical Equipment & Facilities
0
X
X
X
0
0
0
0
0
0
0
0
X
0
0
0
0
X
Adequate Care For Laboratory Equipment
0
0
0
X
0
X
0
0
0
X
0
0
X
0
0
0
X
0
Adequate Records
X
X
X
X
0
X
X
X
X
X
0
0
X
X
X
X
X
X
Fluoride Chemical Feed Equipment And Facilities
Adequate Feeding Equipment and Facilities
X
0
X
X
0
X
X
0
X
X
0
0
0
0
0
X
X
0
Adequate Feeding Arrangements
0
X
X
X
0
X
X
0
0
X
X
0
0
0
X
X
0
0
Feed Interrupted <1-Day In Past 12-Months
0
0
2/
X
0
0
0
X
0
0
0
X
0
X
0
0
0
0
Adequate Maintenance
0
0
0
X
0
X
X
0
0
0
0
0
0
0
0
0
0
0
Fluoride Chemical Compound - Storaqe And Handlinq
Adequate Storage Arrangements
0
X
0
X
0
X
0
0
0
X
0
0
X
0
X
0
0
0
Acceptable Safe Handling Provisions
0
0
0
0
0
0
0
0
0
X
0
0
X
X
0
0
0
0
Satisfactory Disposal Of Shipping Containers
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Operator Training And Interest
Adequately Trained To Operate Feed Equipment
0
0
X
X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Knowledgeable Of Test Equipment & Procedures
0
0
0
X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Accepts And Interested In Fluoridation
X
X
0
X
0
0
0
0
0
0
0
0
0
0
X
0
0
0
Surveillance
Check Samples To State As Required 1J
0
0
0
0
X
0
X
X
0
0
X
0
X
0
0
0
0
0
Installation Inspected By State In Past 12-Months
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
O'--Satisfactory; X - Unsatisfactory
]J Per 1972-73 Laboratory Records, South Dakota Dept. Of Environmental Protection
2/ Fluoridation Started 4/73. No Interruptions In Feed To Date. Of Survey, 9/11/73.
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SOUTH DAKOTA FLUORIDATION PROGRAM EVALUATION
Figure 1
Fluoridated Water Supp,y System Se,ected for study
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